Analysis of clinical utility of abdominopelvic computer tomography in the surveillance of stage I seminoma. A single center evaluation

Aim of the study: To evaluate the clinical utility of abdominopelvic CT performed for oncological surveillance of patients that have undergone radical orchiectomy for Stage I seminoma in a tertiary referral hospital. Materials and methods: The histopathological reports of all patients that underwent orchiectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum testis tumor markers after orchiectomy were included. Follow-up shorter than 12 months was exclusion criteria. Demographic, pathological features and postoperative follow-up data were collected and reviewed with particular regard to abdominopelvic imaging. Results: Of the 133 patients who have undergone orchiectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded because of follow-up shorter than 12 months. Mean follow-up was 63,2 months (IQR: 30–73). The results of 211 abdominopelvic CTs performed for surveillance purpose were reviewed. Two (3,7%) patients developed recurrence of the malignancy; in one the recurrence consisted of a scrotal lump and was diagnosed with ultrasonography (US), while in the second it was a paraaortic nodal metastasis diagnosed with abdominopelvic CT. The recurrence was treated successfully in both patients, that are both still alive. Of note, a single abdominopelvic CT were useful for the detections of relapse in our entire study population. No cancer specific death has been reported. Discussion: Follow-up schedules for stage I seminoma exposes patients to a potential risk of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. A better risk adapted follow-up program is needed in order to offer tailored follow-up schedules and to avoid unnecessary investigations.